1942238522 NPI number — WILFREDO C LARA MD

Table of content: WILFREDO C LARA MD (NPI 1942238522)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942238522 NPI number — WILFREDO C LARA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LARA
Provider First Name:
WILFREDO
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LARA
Provider Other First Name:
WILFREDO
Provider Other Middle Name:
CONSTANTINO
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1942238522
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/27/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 144336
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORAL GABLES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33114-4336
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-643-8871
Provider Business Mailing Address Fax Number:
305-643-8872

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
351 NW 42ND AVE
Provider Second Line Business Practice Location Address:
SUITE 302
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33126-5683
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-643-8871
Provider Business Practice Location Address Fax Number:
305-643-8872
Provider Enumeration Date:
06/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  ME86697 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 269577407 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5730290 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 269577402 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 269577408 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7403 . This is a "MEDICA HEALTHCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 269577405 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 37551 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 2416244 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 7192597 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 269577406 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com